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The objective of this pilot study is to assess the need, desire, and applicability of a mammography promotion project in the emergency department (ED). A convenience sample from the ED of a public University hospital was surveyed to determine their mammography status, interest in a program to promote mammography, and barriers to mammography. The survey included demographics information, health care access, including health insurance and primary care provider, mammography status and date of mammogram, as well as a checklist of potential barriers. Participants were also asked whether they would be interested in mammography promotion in this setting. More than 15% of the 197 women surveyed had never received a mammogram, and more than half had not received 1 in the past year. The most common barriers to mammography were competing demands and money. Three quarters of the women said they would be interested in mammography promotion while waiting for care in the ED. This study provides promise that mammography promotion activities may be appropriately placed in the ED and provides a solid platform from which researchers and nurses may launch efforts to develop preventive health interventions in innovative public health care settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Because patients with heart failure (HF) experience multiple symptoms simultaneously, it is necessary to explore symptom clusters rather than individual symptoms to determine their impact on outcomes. Given gender differences in symptom experience, examination of potential gender differences in clusters is reasonable. OBJECTIVE: The objective of the study was to compare symptom clusters between men and women with HF, differences in patient characteristics among symptom clusters, and the impact of symptom clusters on cardiac event-free survival. METHODS: A total of 331 patients with HF recruited from HF clinics were included (35% were female and 62% were of New York Heart Association classes III/IV). Cluster analysis was used to identify symptom clusters between men and women based on ratings of distress related to 7 symptoms. Analysis of variance or chi test was used to compare characteristics of patient groups that were divided by the median split of total distress scores of each cluster. Cox proportional hazards regression was used to determine whether total scores of symptom distress in symptom clusters predicted time to first cardiac event. RESULTS: Two identical symptom clusters were identified in men and women: a physical symptom cluster composed of dyspnea, fatigue/increased need to rest, fatigue/low energy, and sleep disturbances and an emotional/cognitive symptom cluster composed of worrying, feeling depressed, and cognitive problems. Patients with higher distress from the physical symptom cluster were primarily females and of New York Heart Association classes III and IV (P < .05). Patients with higher distress from the emotional/cognitive symptom cluster were younger than those with lower distress (P < .05). The total symptom distress score in the emotional/cognitive cluster, but not the physical cluster, was an independent predictor of cardiac event-free survival (hazard ratio, 1.18; 95% confidence interval, 1.03-1.37). CONCLUSION: Although distress for individual symptoms may differ between men and women, they both experienced identical symptom clusters. Only the emotional/cognitive cluster predicted a higher risk for a cardiac event. These results suggested that interventions should be developed that consider symptom clusters. Targeting patients who have high distress from emotional/cognitive symptoms may be particularly important as they may be most vulnerable for adverse outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physical symptoms are likely to occur in clusters that may be associated with adverse outcome in patients with heart failure (HF). Despite the importance of early recognition of worsening symptoms in HF management, the impact of physical symptoms on adverse outcome has not been explored in the context of symptom clusters. PURPOSE: The purposes of this study were to explore which physical symptom clusters occur in HF patients and to determine the impact of symptom clusters on event-free survival. METHODS: A total of 421 patients (60% male; 62 [SD, 14] years; 72% New York Heart Association class II/III) completed the modified Memorial Symptom Assessment Scale-Heart Failure to measure physical symptoms during an index hospitalization in Seoul, Korea. Times to first event of cardiac rehospitalization and cardiac death were collected for 12 months after discharge and confirmed by review of hospital records. An agglomerative hierarchical clustering approach with Ward's method was used to identify symptom clusters. Hierarchical Cox hazard regression was used to determine the impact of symptom clusters on cardiac rehospitalization and cardiac mortality. RESULTS: Two distinct symptom clusters, the dyspneic and the weary symptom clusters, occurred in patients with HF. Shortness of breath, difficulty breathing when lying flat, and waking up breathless at night comprised the dyspneic symptom cluster. Lack of energy, lack of appetite, and difficulty sleeping comprised the weary symptom cluster. In hierarchical Cox hazard regression, elevated distress from the weary symptom cluster independently predicted cardiac rehospitalization (hazard ratio, 1.45; 95% confidence interval, 1.09-1.93), and increased distress from the dyspneic symptom cluster independently predicted cardiac mortality (hazard ratio, 2.00; 95% confidence interval, 1.16-3.34). CONCLUSION: The weary and the dyspneic symptom clusters predicted cardiac rehospitalization and cardiac mortality, respectively. Patient education for self-monitoring of symptoms should focus on symptom clusters rather than single symptom. [ABSTRACT FROM AUTHOR]

Introduction: Pregnant women often underreport their smoking status and extent of secondhand smoke (SHS) exposure. Biomarker confirmation is the recommended method to assess smoking behaviors and SHS exposure in both mothers and infants.Objectives: The primary aims are to (a) examine the relationship between smoking behaviors and SHS exposure in mother-baby couplets using maternal and infant hair nicotine and maternal urine cotinine analyses and (b) determine whether there is an association between maternal and infant hair nicotine samples obtained shortly after birth.Discussion: A cross-sectional study with a multiethnic sample of 210 mother-baby couplets assessing SHS exposure.Results: The level of maternal hair nicotine (MHN) was significantly different among three groups: nonsmoking, nonsmoking/passive exposed, and smoking (p < .0001), with nonsmoking and nonexposed women having the lowest level. Urine cotinine was strongly associated with self-reported smoking status (rho = .88; p < .0001). Maternal and infant hair nicotine were correlated, although MHN correlated more strongly with smoking status (rho = .46, p < .0001) than infant hair nicotine (rho = .39, p < .0001).Conclusions: MHN was a more precise biomarker of prenatal SHS exposure than infant hair nicotine; mothers' urine cotinine was strongly correlated with self-reported smoking status. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to determine the demographic, personal, interpersonal and illness factors associated with asthma quality of life (QOL), as self-reported by adolescents from the United States of America (USA) and Iceland. BACKGROUND: Asthma affects 12% of children in the USA and an estimated 9% in Iceland. Limited research has addressed asthma QOL for adolescents. METHODS: This cross-sectional exploratory study included adolescents with asthma (n = 15 from the USA; n = 15 from Iceland), aged 13-17 years, primarily recruited from paediatric practices in central Kentucky, USA and Reykjavik, Iceland. Data were collected in 2006. Adolescents in the USA (47% male) had a mean age of 14.1 years (sd = 1.5); Icelandic adolescents (73% male) had a mean age of 15.1 years (sd = 1.4). Participants completed questionnaires measuring sociodemographic and asthma characteristics, degree of limitations due to asthma, self-rated health, depressive symptoms and asthma QOL. Multiple regression was used to determine predictors of asthma QOL. RESULTS: Gender was statistically significantly associated with QOL. The difference in QOL between adolescents in the USA and Iceland was not statistically significant. Statistically significant predictors of higher asthma QOL were a better rating of overall health (P < 0.01), not having had a severe asthma attack in the last 6 months (P < 0.01), and lower depressive symptoms (P < 0.05). CONCLUSION: Interventions designed to decrease depression and prevent asthma exacerbations may improve QOL for adolescents with asthma. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the relationship of demographic and social influence with initiation of cigarette use among undergraduates. METHODS: Students were mailed anonymous surveys including 437 participants who indicated that they had not smoked cigarettes before age 18. Of those, 107 became late initiators (24%), and 330 remained never smokers (76%). RESULTS: Those who drank alcohol in college and had at least 1 parent with a college education were more likely to initiate smoking than were those who did not drink and neither parent had attended college. CONCLUSIONS: Strategies that focus on reducing alcohol and tobacco use need to be tested. [ABSTRACT FROM AUTHOR]

Purpose: This study assesses the validity of hair nicotine as a biomarker for secondhand smoke (SHS) exposure. Although most biomarkers of tobacco-smoke exposure have a relatively short half-life, hair nicotine can measure several months of cumulative SHS exposure. Design: A cross-sectional study of hospitality-industry workers. Method: Hair samples were obtained from 207 bar and restaurant workers and analyzed by the reversed-phase high-performance liquid chromatography with electrochemical detection (HPLC-ECD) method. Self-reported tobacco use and sources of SHS exposure were assessed. Findings: Higher hair-nicotine levels were associated with more cigarettes smoked per day among smokers and a greater number of SHS-exposure sources among nonsmokers. Number of SHS exposure sources, gender, number of cigarettes smoked per day, and type of establishment predicted hair-nicotine levels. Discussion: Hair nicotine is a valid measure of SHS exposure. It may be used as an alternative biomarker to measure longer term SHS exposure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased anxiety correlates with increased complications after acute myocardial infarction. Anxiety levels and use of anxiolytic agents have not been compared between smokers and nonsmokers hospitalized because of acute myocardial infarction. OBJECTIVES: To compare anxiety level, sociodemographic factors, and clinical variables between smokers and nonsmokers hospitalized with acute myocardial infarction and to examine predictors of use of beta-blockers and anxiolytic agents among smokers and nonsmokers. METHODS: Secondary data analysis of a prospective multisite study on anxiety in 181 smokers and 351 nonsmokers with acute myocardial infarction. Anxiety was measured by using the State Trait Anxiety Inventory and the anxiety subscale of the Basic Symptom Inventory within 72 hours of admission. RESULTS: Smokers reported higher anxiety levels than nonsmokers reported on both anxiety scales. Female smokers reported the highest anxiety and peak pain levels of all, yet women were the least likely to receive anxiolytic agents. Smoking status was not a predictor for anxiety level when sex, peak pain, use of beta-blockers in the hospital, and age were controlled for. However, smokers were twice as likely as nonsmokers to receive an anxiolytic agent and 60% more likely to receive a beta-blocker in the emergency department, and smokers were 80% more likely than nonsmokers to receive an anxiolytic agent during hospitalization when these variables were controlled. CONCLUSIONS: Older female smokers are at risk for complications because they are older than their male counterparts and less likely to receive beta-blockers and antianxiety medications in the emergency department. [ABSTRACT FROM AUTHOR]

Factors associated with perceived risk, interest in screening information, and interest in being screened for lung cancer were examined among current and recent former smokers. Cross-sectional data were analyzed from 585 current and former smokers who participated in 12-month follow-up telephone interviews as part of a population-based cessation intervention trial. Current smokers who were thinking about or preparing to quit were more likely to perceive risk of lung cancer and be interested in lung cancer screening information than those who were not motivated to quit or who were in the process of actively quitting or maintaining abstinence. Smokers who participate in lung cancer screening may be motivated to participate in a broad range of tobacco dependence treatment options. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relationships of adherence to daily peak expiratory flow rate (PEFR) monitoring, recommended for asthma self-management, with self-concept and health locus of control in a sample of 42 children, ages 7 through 11.Design/Methods: Secondary analysis was conducted on data collected as part of our 5-week randomized, controlled asthma self-management clinical trial. During the study, the Piers-Harris Children's Self-Concept Scale (PHCSC) and Children's Health Locus of Control Scale (CHLOC) were administered at baseline (Week 1) and Week 5 for comparison, while adherence to electronically-measured peak flow monitor (PFM) was evaluated during Week 5.Results: Adherence was positively correlated with higher self-concept (r[s] = .33, p = .03) and internal health locus of control (r = .30, p = .05). Adherence to PFM and the intellectual and anxiety subscales of the PHCSC also were positively associated (r[s]= .38, p = .01, in both cases).Conclusions: Children who have a positive self-concept, particularly in the areas of intellect and anxiety, are more adherent to their recommended asthma regimen. Similarly, those who perceive their ability to control their health more positively adhere better to daily PEFR monitoring. These results suggest that children's adherence interventions may need to include components aimed at enhancing self-concept and health locus of control. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study (a) to assess whether there are cultural and gender differences in parents' general well-being, sense of coherence and perception of family hardiness when they have a young child with asthma; and (b) to examine the effects of parents' sense of coherence and well-being on family hardiness. BACKGROUND: Research on hardiness, a resilience factor that fosters adaptation over time, has been widely studied from an individual perspective, but less from the viewpoint of the family unit. In particular, no study was found that assessed how members of a couple interact to affect their family's hardiness. Consideration of this dyadic phenomenon may provide unique insight about how family members interact with each other faced with a challenge, such as the chronic illness of a child. METHODS: A cross-sectional research design was used with a sample of 137 two-parent families [76 from Iceland and 61 from the United States of America (USA)]. Questionnaires measuring sense of coherence, parents' well-being and family hardiness were used, and demographic data were also collected. RESULTS: The most striking differences in well-being were between mothers and fathers. In addition to a lower average on the total score for the well-being scale, mothers had poorer scores than fathers on the subscales of depression, self-control, vitality, and general health. Family hardiness differed between countries. The regression indicated that the individual's sense of coherence, depression and positive well-being (all actor effects), as well as the partner's anxiety (partner effect) all contributed significantly to family hardiness, as did nationality. CONCLUSION: Focused interventions for families with young children with asthma should be developed to enable them to feel more confident in using their resources to meet their demands and increase parents' general well-being and family adaptation. Research is needed to develop and test such interventions, particularly with diverse participant samples, encompassing not only a variety of ethnicities, but also a range of children's ages. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is growing support that cognitive-behavioral interventions may prevent the onset of clinical depression in at-risk individuals. OBJECTIVES: This article describes the long-term effects of a cognitive-behavioral group intervention in reducing depressive symptoms, negative thinking, and chronic stressors in low-income single mothers at risk for clinical depression. STUDY DESIGN: One hundred thirty-six women were randomly assigned to either an experimental or no-treatment control group. The experimental group participated in a 6-hour cognitive-behavioral group intervention targeting identification and reduction of negative thinking. Data were collected on depressive symptoms, negative thinking, and chronic stressors at 1, 6, and 12 months postintervention. RESULTS: The women in the intervention group experienced a greater reduction in depressive symptoms, negative thinking, and the perception of chronic stressors. These positive effects continued over a 12-month period. CONCLUSIONS: Negative thinking can be reduced using thought stopping and affirmations. These interventions are also cost-effective and easy to administer. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test agreement in blood values obtained from a discard method and a push-pull method in samples from central venous catheters in pediatric patients. The discard method causes blood loss beyond what is necessary for blood testing and increases potential for infection each time the central venous catheter is entered. Twenty-eight children ranging in age from 6 months to 12 years were enrolled in the study. A research protocol was developed to pair the 2 methods of blood collection for each sample. The Bland-Altman method was used to test agreement on each blood value for each paired sample. Of the 438 pairs of measured blood values, 420 (95.9%) fell within the limits of agreement. Nurses reported no difficulty in using the push-pull technique to obtain any samples. The push-pull method of obtaining blood specimens from pediatric central venous catheters should be considered. It can eliminate blood loss through discard and can reduce infection because it reduces the number of times a catheter is entered. Copyright © 2004 by Association of Pediatric Oncology Nurses [ABSTRACT FROM AUTHOR]

The relationships between different levels of severity of ambulatory cerebral palsy, defined by the Gross Motor Function Classification System (GMFCS), and several pediatric outcome instruments were examined. Data from the Gross Motor Function Measure (GMFM), Pediatric Orthopaedic Data Collection Instrument (PODCI), temporal-spatial gait parameters, and oxygen cost were collected from six sites. The sample size for each assessment tool ranged from 226 to 1047 participants. There were significant differences among GMFCS levels I, II, and III for many of the outcome tools assessed in this study. Strong correlations were seen between GMFCS level and each of the GMFM sections D and E scores, the PODCI measures of Transfer and Mobility, and Sports and Physical Function, Gait Velocity, and Oxygen Cost. Correlations among tools demonstrated that the GMFM sections D and E scores correlated with the largest number of other tools. Logistic regression showed GMFM section E score to be a significant predictor of GMFCS level. GMFM section E score can be used to predict GMFCS level relatively accurately (76.6%). Study data indicate that the assessed outcome tools can distinguish between children with different GMFCS levels. This study establishes justification for using the GMFCS as a classification system in clinical studies. [ABSTRACT FROM AUTHOR]

The purpose of this research was to examine the physical health of rural mothers and their low birth weight children (<2,500 gm). The health of rural mothers is of concern because rural families have poorer health than urban ones, and as the primary caregiver for the low birth weight child, mother's health affects the child's care and potentially the child's health. In this cross-sectional, exploratory study, in-home interviews were conducted with 48 mothers between 2 weeks and 18 months after their children were discharged from their birth hospitalization. Mothers' physical health and their perceptions of their children's health were assessed. The mothers were more concerned about their children's health than their own (p = .0005). The concerns included uncertainty about the children's future health, growth, and development. Suggestions for community health care providers are addressed. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms and anxiety are common in heart failure patients as well as their spousal caregivers. However, it is not known whether their emotional distress contributes to their partner's quality of life (QoL). This study examined the effect of patients' and partners' depressive symptoms and anxiety on QoL in patient-spouse dyads using an innovative dyadic analysis technique, the Actor-Partner Interdependence Model (APIM).Method: A total of 58 dyads (patient: 43% in males, mean age 62 years, mean ejection fraction 34% +/-11, 43% in New York Heart Association III-IV) participated in the study. Depressive symptoms and anxiety were assessed using the Brief Symptom Inventory. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Dyadic data were analyzed using the APIM with distinguishable dyad regression model. In APIM, actor effect is the impact of a person's emotional distress on his/her own QoL. Partner effect is the impact of a person's emotional distress on his/her partner's QoL.Result: Depressive symptoms exhibited actor effect of both patients (P<.001) and spouses (P<.001) and only partner effect of patients (P<.05) on QoL. Patients and spouses with higher depressive symptoms had poorer QoL. Patients whose spouses had higher depressive symptoms were more likely to indicate their own QoL was poorer. Anxiety has similar actor and partner effects on QoL as depressive symptoms.Conclusion: Interventions to reduce depression and anxiety and to improve patients' QoL should include both patients and spouses. [ABSTRACT FROM AUTHOR]

Background: To compare relative rates of pediatric poisoning before and after COVID-19, including by demographic and urban-rural status, and by agent identified, using data from one university healthcare system and children's hospital., Methods: Using retrospective, cross sectional design from deidentified healthcare claims data, we extracted all encounters with the ICD-10-CM for Poisoning by, Adverse effects of, and Underdosing of drugs, medicants and biological substances (T36-T50) and grouped the encounters as those after state mandates regulating activity came into effect (Post-COVID-19 (3/17/2020-3/18/2021)) Pre-COVID-19 (3/18/2019-3/17/2020). We then compared poisoning agent, age at the time of the encounter, recorded sex, race, ethnicity, rural/urban residence, and visit type using Mann-Whitney U test, chi-square test of association, incidence rates and incident rate ratios between the time periods., Findings: The sample included 1608 unique patients 0-17 years of age and 4216 encounters. We also identified IRRs >1 in nearly every demographic subgroup with the exception of Non-Hispanic Blacks. The comparison of specific drugs or medicants identified a significant decrease in poisoning by Systemic antibiotics (T36); but an increase in Hormones and their synthetic substitutes and antagonists (T38), Non opioid analgesics antipyretic and antirheumatic (T39), Psychotropic Drugs (T39) and Systemic and hematologic agents (T45)., Conclusion: This study identifies pediatric subgroups highly affected by pediatric poisoning during the time-period immediately after the identification of COVID-19 and characterizes the drugs commonly associated with poisonings., Application to Practice: With a further understanding nursing has the potential to impact pediatric poisoning in the inpatient, outpatient and public health setting., Competing Interests: Declaration of competing interest Authors do not have any interests to report related to this work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Aims: Disposable electronic cigarette (e-cigarette) use is becoming more popular among US youth, given the shifting landscape in product marketing, availability and regulation. This study aimed to estimate the prevalence of and test factors associated with the most used e-cigarette product (disposable versus other) among US youth aged 9-18 years who currently use e-cigarettes., Design, Setting and Participants: This was an observational study using cross-sectional data from the US-based 2021 and 2022 National Youth Tobacco Surveys (n = 48 704). We restricted our analytical sample to youth who currently use e-cigarettes (n = 4137). The sample ranged from 9 to 18 years old and was 53.0% female., Measurements: We dichotomized e-cigarette device type to disposable versus all other types (e.g. refillable pods/cartridges). We conducted logistic regression to estimate whether age, sex, race/ethnicity, sexual orientation, frequency of e-cigarette use, nicotine vaping, flavored e-cigarette use and current combustible/non-combustible tobacco use were associated with disposable e-cigarette use, compared with other e-cigarette use., Findings: Among youth who currently use e-cigarettes, 54.5% used disposable e-cigarettes. Older age (17-18 years), relative to younger age (9-14 years) [odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.07-1.91], non-Hispanic Black (versus non-Hispanic White) race/ethnicity (OR = 1.47, 95% CI = 1.01-2.15), any nicotine (versus non-nicotine) vaping (OR = 2.51, 95% CI = 1.96-3.23) and flavored (versus non-flavored) e-cigarette use (OR = 1.93, 95% CI = 1.46-2.56) were associated with increased odds of mainly using disposable e-cigarettes, compared with using other e-cigarette products, whereas current combustible tobacco use (versus non-current) (OR = 0.65, 95% CI = 0.53-0.80) and current non-combustible tobacco use (versus non-current) (OR = 0.58, 95% CI = 0.43-0.78) were associated with lower odds., Conclusion: Disposable e-cigarettes appear to be the most used type of e-cigarette product among US youth. Older age, non-Hispanic Black race/ethnicity, nicotine vaping and flavored e-cigarette use are associated with mainly using disposable e-cigarettes, relative to other e-cigarette products., (© 2024 Society for the Study of Addiction.)

Background: About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care., Objective: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients., Methods: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics., Results: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor., Conclusions: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes., Competing Interests: The authors have no conflicts of interest or funding to declare., (Copyright © 2024 Society of Trauma Nurses.)

Background: In 2019, over 459,000 persons in the United States survived sexual assault, and 21%-26% sought medical treatment. Ideally, trained medical professionals who understand the unique physical and mental health needs of this patient population, such as forensic nurses, would provide care. Yet, the care that forensic nurses and other healthcare providers can offer to sexual violence/abuse survivors is hindered by the lack of understanding of the demographics of those who seek care. With the delineation of highly affected demographic groups, barriers to care can be addressed., Purpose: This study compared rates, demographic characteristics, acuity, and codes for sexual violence/abuse encounters experienced by those patients residing in rural versus urban counties of Kentucky (KY). This included encounters before and after SARS-CoV-2., Methods: Deidentified claims data were extracted for patient encounters billed with the International Classification of Diseases, 10th Revision, Clinical Modification for sexual violence/abuse seen at a university healthcare center serving the Northeastern, Southeastern, and Central regions of KY from October 2015 to February 2021. Analysis comprised descriptive statistics, independent samples t tests, and chi-square tests of association., Results: Significant demographic differences were identified between the two groups. The mean age of those residing in rural areas was significantly younger than those living in urban areas. Similarly, the percentage of male survivors was significantly higher in the rural population. The racial composition also differed, with higher percentages of survivors being Black and Hispanic in the urban population, relative to rural dwellers., Conclusion: Findings suggest that rural youth (especially boys aged 10 years and younger) and urban minorities are at a higher risk for sexual violence/abuse in KY when compared with their counterparts (i.e., urban youth and rural minorities)., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 International Association of Forensic Nurses.)

Background and Purpose: We utilized the Perceived Racism Scale-Racism on the Job subscale-to assess how frequently Black nurses experienced racism on the job in the past year (ROTJ-Y) and throughout their lifetime (ROTJ-L). We aimed to assess the reliability and assess construct validity of each subscale in a sample of 53 nurses. Methods: Reliability was evaluated using coefficient alphas, item correlations, and interitem correlations. Construct validity was examined using exploratory factor analysis. Results: Results demonstrated that the subscales are reliable and valid. Coefficient alphas for the ROTJ-Y and ROTJ-L were .93 and .91, respectively. Exploratory factor analysis revealed a unidimensional factor for both subscales. Conclusion: This study demonstrated that the Racism on the Job subscales are psychometrically sound measures of workplace racism among Black nurses., (© Copyright 2024 Springer Publishing Company, LLC.)

Introduction: Because medication adherence is essential to the management of rheumatoid arthritis (RA), identifying (1) subgroups at high risk for low medication adherence and (2) modifiable factors potentially contributing to low adherence can impact patient outcomes. This study aims to describe the relationships between anxiety, trust in the provider, quality patient-provider communication, fatigue, RA knowledge, adverse medication effects, disease activity, RA medications, disease duration, patient satisfaction, and medication intolerance and cluster factors to differentiate RA-patient subgroups., Methods: This observational study used correlation analysis, linear regression, and cluster analysis with determination decisions based on Schwarz's Bayesian Criterion., Results: Medication adherence was higher in non-Hispanic, White participants, inversely correlated with disease activity and pain intensity, and positively correlated with trust in the provider. Patient satisfaction was higher among those with a shorter time since diagnosis, and was negatively associated with disease activity, pain intensity and interference, fatigue, and anxiety. It was positively associated with RA knowledge, trust in provider and quality of patient-provider communication. Medication intolerance differed by disease duration and was positively correlated with disease activity, pain interference, and fatigue. Of the two clusters, Cluster 1 participants had greater medication adherence and patient satisfaction, and lower medication intolerance. They were of higher income, employed, and non-Hispanic, White persons with a shorter disease duration and lower perceived pain intensity/interference, fatigue, and anxiety. They were more knowledgeable about RA with higher trust in their provider and perceived quality of patient-provider communication., Discussion/conclusion: A low medication adherence RA-patient subgroup-highly affected by social determinants of health and with unique relational and clinical characteristics was identified., (© 2024 John Wiley & Sons Ltd.)

Background: Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non-caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self-care, is predictive of health outcomes and CVD risk in several populations. However, it is not known whether health activation is associated with CVD risk in rural caregivers of patients with chronic illnesses nor is it clear whether sex moderates any association., Objectives: Our aims were to determine (1) whether health activation independently predicts 10-year CVD risk; and (2) whether sex interacts with health activation in the prediction of 10-year CVD risk among rural family caregivers (N = 247) of patients with chronic illnesses., Methods: Health activation was measured using the Patient Activation Measure. The predicted 10-year risk of CVD was assessed using the Framingham Risk Score. Data were analyzed using nonlinear regression analysis., Results: Higher levels of health activation were significantly associated with decreased risk of developing CVD (p < 0.028). There was no interaction of sex with health activation on future CVD risk. However, male caregivers had greater risk of developing CVD in the next 10 years than female caregivers (p < 0.001)., Conclusions: We demonstrated the importance of health activation to future CVD risk in rural family caregivers of patients with chronic illnesses. We also demonstrated that despite the higher risk of future CVD among male, the degree of association between health activation and CVD risk did not differ by sex., (© 2024 National Rural Health Association.)

Background: Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers., Methods: We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness., Results: In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness., Conclusions: Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity., Clinicaltrials.gov Registration: NCT05876325., (© The Author(s) 2024. Published by Oxford University Press.)

Objective: Relatively few dyad-based studies have evaluated the shared psychosocial and financial toxicity (FT) experiences of hematologic patients and their caregivers, especially those undergoing bone marrow transplantations (BMTs). This study evaluated the association of FT with health-related quality of life (QOL) among BMT patient-caregiver dyads., Methods: Survey and electronic health record data were collected between April 2021 and January 2022 from BMT patients and their caregivers pre- (T1) and post-intervention (T2). Thirty-four patient-caregiver dyads completed surveys; all dyads included a patient experiencing elevated T1 FT. The effect of the total FT score (i.e., the combination of psychological response, coping behaviors, and material conditions domain scores) on physical health, mental health, anxiety, depression and distress scores was evaluated using Actor-Partner Interdependence Modeling (APIM)., Results: Patients and caregivers who reported lower total FT scores had better physical and mental health, and lower anxiety, depressive symptoms, distress (APIM actor effects). None of the partner effects were significant in the APIM models. Other model findings indicated that compared with caregivers, patients had lower reported physical health; mental health scores were higher, on average, for all participants at the T2 compared with T1; and members of dyads whose caregiver took time off work reported better physical health and lower depressive symptoms and distress than those whose caregiver did not., Conclusions: Our study addresses a significant gap in dyad-based cancer FT studies; the findings underscore the need for additional research to help develop tailored dyad-level FT interventions for improving health-related QOL among BMT patients., (© 2024 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.)

Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public's access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron-staff interactions mainly included discussions about the logistics of radon testing. Given that public libraries are invested in making communities thrive and promoting health, providing library lending programs for radon detectors is a novel, feasible, and acceptable way to reduce the risk of lung cancer in the community., Competing Interests: Declaration of interest: none.

Objective: To evaluate the psychometric properties of the Breastfeeding and Employment Scale (BES)., Design: Secondary analysis of data from the Infant Feeding Practices Study II survey, a longitudinal study on infant feeding practices., Setting: United States., Participants: Women who were employed, breastfeeding, and completed the Infant Feeding Practices Study II BES at the 3-month postpartum assessment (N = 508)., Methods: Participants reported their perceived level of breastfeeding support in the workplace by responding to the nine binary items on the BES. We evaluated the instrument's internal consistency reliability (Kuder-Richardson 20), test-retest reliability (Cohen's kappa), construct validity (principal component analysis), and convergent validity (relationship with a similar item)., Results: The internal consistency of the BES (Kuder-Richardson 20 = 0.72) supported the reliability of scale. The test-retest reliability was moderate (0.41-0.60). The Spearman's rho correlation coefficient was 0.66, indicating adequate test-rest reliability for the total BES score between the 3-month and 6-month assessments (p < .01). The factor analysis demonstrated that the items cluster into one factor (psychosocial and structural barriers to breastfeeding in the workplace). Participants who reported more barriers to breastfeeding in the workplace also reported a less supportive workplace environment, which supported the convergent validity of the scale., Conclusion: The psychometric testing of the BES provided initial support for the reliability and validity of the instrument. It may be a useful tool for measuring workplace lactation support in a concise manner., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2023 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: Rates of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), a withdrawal syndrome from opioids and other substances resulting from intrauterine exposure, have been increasing exponentially in the U.S. To improve health outcomes, it is important to understand population health risks, including rehospitalization and related diagnoses, using current data. This study will compare and describe the rates of rehospitalization, the demographic characteristics and the rehospitalization diagnoses and age at diagnosis between the infants affected by NAS/NOWS to those sampled who were unaffected. This study will also describe the frequency of NAS/NOWS births per year along with a yearly comparison of readmissions in those affected by NAS/NOWS to those who were not (2016-2020)., Methods: Health claims data were used to conduct a case/control study. Diagnosis codes for neonatal withdrawal syndrome/NAS/NOWS (P04.49 or P96.1 and P96.1 alone) from 1 October 2015 to 1 June 2021 were extracted, and controls were case-matched based on month/year of birth. Rehospitalizations following birth and the related diagnoses were described and grouped using the Agency of Healthcare Research Quality Clinical Classifications Software Refined Frequency distribution. The chi-square test of association and generalized estimating equation modeling were used for data analysis., Results: Infants affected by NAS/NOWS are 2.7 times more likely to have a rehospitalization. White, non-Hispanic neonates (OR = 1.5; p  = .007) and those infants residing in rural areas (OR = 1.9; p  < .001) were disproportionately affected. We identified a host of admission diagnoses with increased prevalence in infants affected by NAS/NOWS when compared to those who were not affected (e.g. infectious diseases, feeding disorders)., Conclusions: Infants with NAS/NOWS are at increased risk of rehospitalization with a host of diagnoses, and specific demographic groups (White, rural) are more highly affected.

Background: Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk. The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for known risk factors in incarcerated men., Methods: We included data from 349 incarcerated men to examine race and CVD risk (Framingham Risk Score) using a serial mediation model with health literacy and perceived control using 95% confidence intervals (CIs) from 5000 bootstrap samples., Results: Of the participants (age, 36 ± 10; education, 12 ± 2; body mass index, 28.3 ± 5.0), 64.2% were White and 35.8% were Black. Black incarcerated men were younger (P = .047) with lower levels of health literacy (P < .001). All 3 indirect effects of race on CVD were significant, whereas the direct effect of race was not. Black incarcerated men had higher levels of CVD risk through health literacy (a1b1 = 0.3571; 95% CI, 0.0948-0.7162) and lower levels of CVD risk through perceived control (a2b2 = -0.1855; 95% CI, -0.4388 to -0.0077). Black incarcerated men had higher levels of CVD risk through health literacy influenced by perceived control (a1b2d21 = 0.0627; 95% CI, 0.0028-0.1409), indicating that despite the protective effect of higher levels of perceived control in Black incarcerated men, CVD risk remained higher compared with their White counterparts., Conclusion: Future CVD risk reduction interventions in incarcerated men, specifically Black incarcerated men, should include goals of improving health literacy and perceived control as modifiable risk factors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this study was to determine whether COVID-19 impact and Diabetes Self-Management Education and Support (DSMES) service attendance predicted diabetes distress among individuals with type 2 diabetes during the pandemic., Methods: Eighty-six adults with type 2 diabetes who either attended (n = 29) or did not previously attend (n = 57) DSMES services completed a cross-sectional survey. Participants' mean age was 57 ± 12.3 years, 50% were female, and 71.3% were diagnosed with diabetes >5 years. The Coronavirus Impact Scale was used to measure impact of the pandemic on daily life. The Diabetes Distress Scale was used to measure distress overall and within 4 subscales (emotional burden, interpersonal distress, physician-related distress, regimen distress). Separate multiple linear regressions were conducted for each outcome, controlling for age, sex, marital status, financial status, and time since diabetes diagnosis., Results: Higher COVID-19 impact predicted higher diabetes-related distress for all subscales and overall. Only the subscale for interpersonal distress was predicted by DSMES attendance, which decreased with DSMES attendance., Conclusion: This study identifies a link between the effects of the COVID-19 pandemic and diabetes distress. The findings highlight the negative impact of the pandemic on diabetes distress and the importance of DSMES services for diabetes-related distress. Interventions are needed to reduce psychological distress among this population during public health crises.

The first Doctor of Nursing Practice (DNP) program was opened at the University of Kentucky College of Nursing (UKCON) in 2001. As the CON celebrates 20 plus years of DNP education, leaders decided to do an assessment of the accomplishments and outcomes from the work of graduates. The purpose of this study was to delineate the achievements, outcomes and perception of the impact of graduates from the UKCON DNP program and assess the correlations of specific "perception of impact" variables. DNP graduates from 2005 to 2021 (n = 348) received an email about the study and a link to the survey. Ninety graduates who resided in 14 states responded. Over 84 % of participants indicated that their DNP degree helped them stand out as a leader. Participants reported that having a DNP education increased their knowledge and expertise in multiple areas, including how to lead, to influence, and to improve outcomes within their organizations. Narrative feedback related to top achievements since graduation included career advancement/promotion (n = 22), improving patient care quality/implementation of evidence-based initiatives (n = 21), and becoming a better leader (n = 19). This study illustrated the broad return on investment and the quantification of value that a DNP education brings, both to practice and academia., (Copyright © 2023. Published by Elsevier Inc.)

Background: The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers., Objectives: This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs., Methods: We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships., Results: The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies., Discussion: This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Exposure to tobacco smoke and radon cause lung cancer. Radioactive decay of naturally occurring uranium in bedrock produces radon. Seasonality, bedrock type, age of home, and topography have been associated with indoor radon, but the research is mixed. The study objective was to examine the relationships of geologic (soil radon and bedrock) and seasonal (warm and cold times of the year) factors with indoor home radon values in citizen scientists' homes over time, controlling for atmospheric conditions, topography, age of home, and home exposure to tobacco smoke. We collected and analyzed indoor radon values, soil radon gas concentrations, and dwelling- and county-level geologic and atmospheric conditions on 66 properties in four rural counties during two seasons: (1) summer 2021 ( n = 53); and (2) winter/spring 2022 ( n = 52). Citizen scientists measured indoor radon using Airthings radon sensors, and outdoor temperature and rainfall. Geologists obtained soil radon measurements using RAD7 instruments at two locations (near the dwelling and farther away) at each dwelling, testing for associations of indoor radon values with soil values, bedrock type, topography, and atmospheric conditions. Bedrock type, near soil radon levels, home age, and barometric pressure were associated with indoor radon. Dwellings built on carbonate bedrock had indoor radon values that were 2.8 pCi/L (103.6 Bq m -3 ) higher, on average, compared to homes built on siliclastic rock. Homes with higher near soil radon and those built <40 ago were more likely to have indoor radon ⩾4.0 pCi/L (148 Bq m -3 ). With higher atmospheric barometric pressure during testing, observed indoor radon values were lower. Seasonality and topography were not associated with indoor radon level. Understanding relationships among bedrock type, soil radon, and indoor radon exposure allows the development of practical predictive models that may support pre-construction forecasting of indoor radon potential based on geologic factors., Competing Interests: Conflict of interest The authors declare they have nothing to disclose.